Clinical features of patients with hepatic portal venous gas

Manato Fujii,Kazuki Yamasaki,Yoshiharu Takenaka,Jo Tashiro,Mayuko Tanaka,Yukiyoshi Masaki,Suguru Yamashita

doi:10.1186/s12893-020-00973-8

Manato Fujii, Kazuki Yamasaki + Show 5 more

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https://doi.org/10.1186/s12893-020-00973-8

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Journal: BMC Surgery	Publication Date: Nov 27, 2020
Citations: 7	License type: open-access

Affiliation: Ome Municipal General Hospital

Abstract

BackgroundHepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated.MethodsThirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n = 12 [40%]) and without (Group 2; n = 18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia.ResultsAt admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment.ConclusionsEarlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.

Highlights

Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases
With regard to the computed tomography (CT) findings, the incidence of a combination of intestinal pneumatosis (IP) and HPVG in Group 1was significantly higher than that in Group 2, but there were no significant differences between Groups 1 and 2 with regard to the prevalences of ascites or free air, or the distribution of HPVG
receiver operating characteristic (ROC) analyses revealed that Base excess (BE) (AUC 0.831, p = 0.005), lactate (AUC 0.850, p = 0.003), and C-reactive protein (CRP) (AUC 0.819, p = 0.007) were significantly associated with bowel ischemia and the optimal cut-off values for the prediction of bowel ischemia were − 5.5 mmol/L, 3.5 mmol/L, and 4.4 mg/ dL, respectively (Additional file 1: Fig. S1B, C, D)

Summary

Introduction

Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. The factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated. Hepatic portal venous gas (HPVG), which was first recognized in neonates by Wolf et al [1] and in adults by Susman et al [2], has been reported to be associated with three major inciting factors: bowel mucosal damage, bowel distention, and sepsis [3]. The factors involved in the accurate prediction of bowel ischemia in patients with HPVG have not been able to be fully investigated to date

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